Although duct-to-duct anastomosis has been shown as a feasible option for biliary reconstruction in patients undergoing orthotopic liver transplantation (OLT) for end-stage primary sclerosing cholangitis (PSC), it remains unclear whether there is any difference in long-term outcome compared with reconstruction using a Roux-en-Y hepatico-jejunostomy.
The aim was to evaluate the long-term outcome after OLT for PSC using either duct-to-duct or Roux-en-Y biliary reconstruction.
Between January 1, 1991 and December 31, 2011, a total of 98 adult patients underwent OLT for PSC in our center with either a duct-to-duct anastomosis or a Roux-en-Y hepatico-jejunostomy. Median follow up was 8.2 years. Patient characteristics, postoperative complications, patient and graft survival rates, as well as short-term and long term biliary outcome parameters were compared between groups in a retrospective analysis of a prospectively collected database.
Duct-to-duct biliary reconstruction was performed in 45 patients and Roux-en-Y hepatico-jejunostomy in 53 patients. There were no significant differences in patient demographics and general surgical variables between groups. Overall patient and graft survival rates were similar in the two groups. The incidence of biliary strictures and biliary leakage within one year after transplantation did not differ among the groups, however, significantly more patients in the Roux-en-Y group suffered at least one episode of cholangitis within the first year (25% versus 9%; p=0.04). In addition, Roux-en-Y reconstruction was associated with a significant higher rate of late onset (>1 year post-transplant) non-anastomotic biliary strictures compared to the duct-to-duct group (24% versus 7% at 5 years and 30% versus 7% at 10 years; p=0.01).
The use of duct-to-duct biliary reconstruction in patients with PSC is associated with lower incidences of post-transplant cholangitis and late-onset non-anastomotic biliary strictures, compared to Roux-en-Y hepatico-jejunostomy. If technically and anatomically feasible, duct-to-duct anastomosis should be the preferred technique of biliary reconstruction in patients undergoing OLT for PSC.
To cite this abstract in AMA style:Sutton M, Bense R, Lisman T, Jagt Evander, Berg Avanden, Porte R. Duct-to-Duct Biliary Reconstruction in Liver Transplantation for Primary Sclerosing Cholangitis Is Associated with Less Biliary Complications, Compared with Roux-en-Y Hepatico-Jejunostomy [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/duct-to-duct-biliary-reconstruction-in-liver-transplantation-for-primary-sclerosing-cholangitis-is-associated-with-less-biliary-complications-compared-with-roux-en-y-hepatico-jejunostomy/. Accessed February 26, 2020.
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